Great-West Life (Canada Life) Insurance Claim Denied: How to Appeal

Great-West Life rebranded as Canada Life in 2020 and is now one of Canada's largest providers of group benefits and individual insurance. Canada Life administers group benefits for hundreds of thousands of Canadian employees, manages the Public Service Health Care Plan for federal government employees, and sells individual life, critical illness, and long-term care products. If Canada Life has denied your disability, health, dental, or life insurance claim, the denial is not necessarily the end of the road. Canadian law and the country's independent dispute resolution system provide meaningful avenues to challenge it.

Why Canada Life Denies Claims

Canada Life denials fall into predictable patterns depending on the product type involved:

• Long-term disability: Canada Life applies either an "own occupation" definition during the first two years or an "any occupation" definition after two years, depending on your policy. Denials frequently cite insufficient functional capacity evidence, challenge treating physician opinions through independent medical examinations (IMEs), apply pre-existing condition limitations, subject mental health conditions to a two-year benefit cap, or terminate benefits by claiming you can perform modified duties
• Group health and dental: Denials cite treatment not covered under the plan's benefit schedule, annual or lifetime benefit maximums reached, services deemed not medically necessary, missing pre-authorization, provider eligibility issues, or coordination of benefits disputes
• Critical illness: Claims denied for not meeting the strict policy definition of the covered condition, survival period not met (typically 30 days post-diagnosis), or alleged non-disclosure of medical history at application
• Life insurance: Denials invoke material misrepresentation during the contestability period (typically two years), policy lapse for non-payment, or an exclusion clause such as suicide, fraud, or excluded activity

Understanding the exact basis for your denial shapes every step of the appeal strategy.

How to Appeal a Canada Life Denial

Step 1: Request the Full Denial and Complete Claim File

Canada Life must provide written reasons for any denial. Send a written request for the full denial letter, all documents in your claim file, any IME reports, file reviews, surveillance records, and vocational assessments they relied upon. You are legally entitled to see everything they used in making their decision. Record the date of your request and keep a copy. For LTD claims in particular, the claim file often reveals gaps or inconsistencies in Canada Life's rationale.

Step 2: Review Your Policy and Group Benefits Booklet

Read the exact language of the policy provision or exclusion cited in the denial. Confirm whether the denial reason matches your actual policy terms — clerical errors and misapplied exclusions occur regularly, and plan administrators sometimes apply the wrong version of a group benefits booklet. The exact definition of disability, pre-existing condition, or covered critical illness in your contract is controlling.

Step 3: Compile Your Supporting Documentation

Gather complete medical records from all treating physicians and specialists relevant to the claim, clinical notes, test results, imaging, and specialist reports. Obtain a detailed letter from your treating physician or specialist specifically addressing Canada Life's stated denial reason point by point. For LTD claims, a functional capacity evaluation conducted by an independent occupational therapist can be decisive. For critical illness claims, your specialist's letter should address the policy definition of the covered condition and confirm your diagnosis meets that definition.

Step 4: File the Internal Appeal

Submit your appeal in writing within the deadline stated in your denial letter. Your letter should identify the specific denial reason, refute it with medical evidence and policy language, reference applicable clinical guidelines or medical literature, request review by a qualified medical professional in the relevant specialty, and cite your policy language supporting coverage. For LTD denials involving complex medical or legal issues, engaging a disability lawyer or benefits advocate early in the process is advisable.

Step 5: Escalate to Canada Life's Appeals Committee

Canada Life has an internal appeals committee that reviews contested claims. If your initial appeal is denied by the claims team, escalate formally to this committee with any additional evidence not previously submitted, including updated medical records, a new specialist opinion, or a rebuttal of Canada Life's IME findings with a report from your own physician or an independent medical expert.

Step 6: File a Complaint with OLHI

The OmbudService for Life and Health Insurance (OLHI) at olhi.ca is the independent dispute resolution service for Canadian life and health insurers including Canada Life. Contact them at 1-888-295-8112. You must exhaust Canada Life's internal appeals process before OLHI will accept your complaint. OLHI reviews the file, facilitates resolution, and makes a recommendation. If Canada Life does not accept the recommendation, you retain all legal rights. The service is free to consumers.

What to Include in Your Appeal

• Full denial letter and claim file, including any IME reports or surveillance materials Canada Life relied upon
• Insurance policy or group benefits booklet with the specific provision at issue highlighted and annotated
• Complete medical records from all treating providers with clinical notes establishing diagnosis, functional limitations, and treatment history
• Treating physician or specialist letter specifically addressing and rebutting each of Canada Life's stated denial reasons
• Functional capacity evaluation or independent medical assessment (for LTD claims), and vocational assessment rebuttal if one was used against you

Fight Back With ClaimBack

Canada Life denials — especially for LTD and critical illness claims — are often based on overly narrow policy interpretations or selective reliance on IME findings that conflict with your treating physician's conclusions. A well-organized, evidence-based appeal that directly confronts Canada Life's specific rationale frequently produces different results than the initial claim decision. ClaimBack generates a professional appeal letter in 3 minutes.

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Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal